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Street Talk Newsletter

When You See Schizophrenia

Mr. J. always seemed a bit odd, but he didn’t really bother anybody, so the neighbors didn’t pay much attention to him anymore. But late one night, a neighbor heard him yelling out in the street, and decided to call the police. When they arrived, Mr. J. was still outside, very agitated, and arguing with someone, but no one else was outside or in the house. Officers started talking with him, but his words didn’t make a lot of sense. He clearly was upset and scared, stating more than once that “people are trying to get me” and “they want me to do things I don’t want to do.” He described how “agents” kept commanding him to “take out the alarms and security systems” at the bank or “they will kill me.”

As a police officer, probably one of the biggest challenges related to mental illness is trying to talk with someone who is in a psychotic state. Psychosis can occur for several reasons, but schizophrenia is the illness most often associated with it. Even though it affects only 1% of the population, schizophrenia can be severe and debilitating if untreated or not well-managed medically.

Hallucinations (unreal sensory perceptions), delusions (strongly held false beliefs), along with disordered thinking and behavior, are the hallmark symptoms.

When a person is having a psychotic episode, it can be very difficult to keep him or her focused. He/she might appear to intentionally ignore your questions, conversation, or instructions. During psychosis, a person’s brain circuitry misfires, creating false thoughts, feelings and sensations so intensely that it’s difficult for the person to pay attention to what is real. These false pieces of information can affect all five senses, and feel 100% real to the person.

Hallucinations and delusions are almost always negative, dark or derogatory, causing a person to be very agitated and afraid.

While it’s useful to ascertain the nature of the hallucinations or delusions, “playing along” is not recommended.

Being respectful and verbally acknowledging the person’s distress - without tolerating dangerous or inappropriate behavior - will be more productive in the long run.

Remember, the voices, sensations and beliefs feel very real to the person.

Schizophrenia is a degenerative illness, that when left untreated, gets worse over time, and results in structural changes to the brain. It is a chronic condition, requiring consistent and lifelong treatment.

Symptoms generally fall into three categories: positive, negative and cognitive.

Positive - In this instance, “positive” does not equal “good.” In this case, positive refers to something being added, excessive or distorted in normal functions and can include:

Delusions - One of the most common symptoms, delusions are strongly held beliefs that are not based in reality, and usually involve misinterpretation of perception or experience. Delusions are sometimes grandiose, sometimes paranoid.

Hallucinations - These involve sensory perceptions that do not actually exist in reality, but feel real, and can affect any of the five senses. Hearing voices – usually very negative and derogatory in nature - is the most common type of hallucination.

Thought disorder - Difficulty speaking and organizing thoughts can result in stopping speech mid-sentence or putting together meaningless words, sometimes known as "word salad."

Disorganized behavior - This can show in a number of ways, ranging from childlike silliness to unpredictable agitation.

Negative - This refers to a diminishment or absence of characteristics of normal function. They can appear months or years before positive symptoms, and include:

Loss of interest in everyday activities

Appearing to lack emotion

Reduced ability to plan or carry out activities

Neglect of personal hygiene

Social withdrawal

Loss of motivation

Cognitive – These involve problems with thought processes and are often the most disabling because they interfere with a person’s ability to perform routine daily tasks.

Problems making sense of information

Difficulty paying attention

Memory problems

Schizophrenia also can affect mood, causing depression or mood swings. In addition, people with schizophrenia often seem inappropriate and odd, causing others to avoid them, which leads to social isolation.

Causes
Although the precise cause isn't known, researchers have identified factors that seem to increase the risk of developing or triggering schizophrenia, including:

Having a family history of schizophrenia

Exposure to viruses, toxins or malnutrition while in the womb, particularly in the first and second trimesters

Stressful life circumstances

Older paternal age

Taking psychoactive drugs during adolescence and young adulthood

Prevention
There's no sure way to prevent schizophrenia, but early treatment has the potential to get symptoms under control before serious complications develop, which also improves long-term prognosis. Sticking with the treatment plan can help prevent relapses or worsening of schizophrenia symptoms.